Background: Stroke and aphasia can have a profound impact on people's lives, and depression is a common, frequently persistent consequence. Social networks also suffer, with poor social support associated with worse recovery. It is essential to support psychosocial well-being post-stroke, and examine which factors facilitate successful adjustment to living with aphasia. Aims: In the context of a feasibility randomized controlled trial of peer-befriending (SUPERB), this qualitative study explores adjustment for people with aphasia in the post-acute phase of recovery, a phase often neglected in previous research. Methods & Procedures: Semi-structured interviews were conducted with 20 people with aphasia and 10 significant others, who were purposively sampled from the wider group of 56 people with aphasia and 48 significant others. Interviews took place in participants' homes; they were analysed using framework analysis.Outcomes & Results: Participants with aphasia were 10 women and 10 men; their median (interquartile range-IQR) age was 70 (57.5-77.0) years. Twelve participants had mild aphasia, eight moderate-severe aphasia. Significant others were six women and four men with a median (IQR) age of 70.5 (43-79) years. They identified a range of factors that influenced adjustment to aphasia post-stroke. Some were personal resources, including mood and emotions; identity/sense of self; attitude and outlook; faith and spirituality; and moving forward. Significant others also talked about the impact of becoming carers. Other factors were external sources of support, including familial and other relationships; doctors, nurses and hospital communication; life on the ward; therapies and therapists; psychological support, stroke groups; and community and socializing.Conclusions & Implications: To promote adjustment in the acute phase, hospital staff should prioritize the humanizing aspects of care provision. In the post-acute phase, clinicians play an integral role in supporting adjustment and can help by focusing on relationship-centred care, monitoring mental health, promoting quality improvement across the continuum of care and supporting advocacy.

This study showed that 21 people with dysgraphia improved on a functional writing measure following therapy using assistive technology. The results suggest that treatment compensated for, rather than remediated, the impairment, given that unassisted writing did not change. Further studies of technology-enhanced writing therapy are warranted.

Purpose This study investigated the effects of technology-enhanced reading therapy for people with reading impairments, using mainstream assistive reading technologies alongside reading strategies. Method The study used a quasirandomized waitlist controlled design. Twenty-one people with reading impairments following stroke were randomly assigned to receive 14 hr of therapy immediately or after a 6-week delay. During therapy, participants were trained to use assistive reading technology that offered a range of features to support reading comprehension. They developed skills in using the technology independently and in applying the technology to their personal reading goals. The primary outcome measure assessed reading comprehension, using Gray Oral Reading Test–Fourth Edition (GORT-4). Secondary measures were as follows: Reading Comprehension Battery for Aphasia–Second Edition, Reading Confidence and Emotions Questionnaire, Communication Activities of Daily Living–Second Edition, Visual Analog Mood Scales, and Assessment of Living With Aphasia. Matched texts were used with the GORT-4 to compare technology-assisted and unassisted reading comprehension. Mixed analyses of variance explored change between T1 and T2, when the immediate group had received therapy but the delayed group had not, thus serving as untreated controls. Pretherapy, posttherapy, and follow-up scores on the measures were also examined for all participants. Results GORT-4 results indicated that the immediately treated group improved significantly in technology-assisted reading following therapy, but not in unassisted reading. However, the data were not normally distributed, and secondary nonparametric analysis was not significant. The control group was unstable over the baseline, improving significantly in unassisted reading. The whole-group analysis showed significant gains in assisted (but not unassisted) reading after therapy that were maintained at follow-up. The Reading Confidence and Emotions Questionnaire results improved significantly following therapy, with good maintenance of change. Results on all other secondary measures were not significant. Conclusions Technology-assisted reading comprehension improved following the intervention, with treatment compensating for, rather than remediating, the reading impairment. Participants' confidence and emotions associated with reading also improved. Gains were achieved after 14 therapy sessions, using assistive technologies that are widely available and relatively affordable, meaning that this approach could be implemented in clinical practice.

Background: Aphasia negatively impacts face-to-face social participation and the difficulties that people experience using the phone exacerbate these challenges in staying in touch with family and friends. Videoconferencing enables multimodal communication, and teamed with supported conversation, could facilitate access to conversation and thereby increase social participation for people with chronic aphasia. Aims: This pilot study examined whether supported conversation provided over Skype could improve people's social participation. It reports on preliminary outcomes of this intervention on people's social network, communication confidence, aphasia-related quality of life and mood. Methods & Procedures: 29 participants with chronic aphasia received an initial 2-hour technology training session followed by 16hours of online supported conversation for participation intervention provided by qualified or student speech and language therapists. Intervention was personalised by individualising goals in technology, communication and participation. An observational prospective cohort study design was used with baseline, immediately post-intervention, and 8-week follow-up assessments. Measures of social network and communication confidence (primary outcome measures), and aphasia-related quality of life, life participation, and mood (secondary outcome measures) were undertaken. Shapiro-Wilk tests were conducted to examine normality of distributions of each of the variables. Where data were normally distributed, one-way repeated measures ANOVAs were used to examine the effect of time. Where data were not normally distributed, Wilcoxon Signed Ranks test was used.Outcomes & Results: 27 participants completed the intervention. As a group, participants reported significantly more social contacts, more life participation, and higher aphasia-related quality of life post-intervention, which were maintained. There was a group gain on the measure of communication confidence post-intervention, although this was not maintained. As a group, participants' mood did not significantly change through intervention and follow-up. Individual variability was noted across all outcome measures.Conclusions: These preliminary findings suggest that relatively low dose and non-intensive online supported conversation for participation intervention delivered by qualified or student speech and language therapists improved social participation in some people with aphasia and improved their quality of life. Communication confidence also improved for some, although benefits were short-term. Findings make novel contributions to the existing supported conversation evidence base with positive social participation and quality of life outcomes, likely achieved by the explicit participation focus. Whilst preliminary findings are positive, study limitations need addressing. Further investigations are merited to refine the intervention and outcome measure choice, and capture feasibility data. Finally, a definitive controlled trial is needed to explore clinical e...

Purpose: Peer-befriending, where support is offered by someone with shared lived experience, is an intervention that may facilitate successful adjustment in people experiencing post-stroke aphasia. This paper explores the experiences of the peer-befrienders. Materials and methods: People with aphasia were recruited as peer-befrienders within the SUPERB trial investigating befriending for people with post-stroke aphasia. The intervention comprised six visits over three months. Peer-befrienders were matched with at least one befriendee and received training and ongoing supervision. They were invited to participate in in-depth interviews which were analysed using framework analysis. Results: All 10 befrienders participated in interviews, reporting on 19 matches. Seven main themes emerged: content of the sessions; befriender-befriendee relationship; negotiating the visits; handling boundaries and endings; positive impact of the befriending for befrienders and befriendees; and beliefs about the nature and value of peer support. While befrienders described challenges, such as negotiating journeys and witnessing distress, the role was perceived as a "secure challenge" due to the support and training received. Conclusions: Befrienders perceived the role as enjoyable and rewarding, and felt they were making a positive difference. They were unanimous in believing that people with aphasia can offer unique and valuable support to others with aphasia. Trial registration: ClinicalTrials.gov identifier NCT02947776, registered 28th October 2016. ä IMPLICATIONS FOR REHABILITATIONPeople with lived experience of stroke and aphasia were able to offer emotional and social peer support to others with aphasia within the SUPERB trial. Although there were challenges, peer befrienders perceived the role as rewarding and satisfying. Peer befrienders valued the training and ongoing supervision and support they received to deliver the intervention. It is recommended that rehabilitation professionals considering offering peer-befriending schemes provide training and ongoing supervision to support peer-befrienders fulfil their role, as well as practical support with, e.g., arranging visits.